application742 Bay Road,Queensbury,NY 12804
Dave Hatin,Director codes@aueensburnet
Phone:(516)761-8256 FAX:(518)745-4437
Accessory Structure Builaitg!Permit Application
=See.Dermal bape =BP30S14/pert No,ZOE U
suing &Codes Off —Deparnent of Communly Devetopment-Toon ofaueensbuy Fee Paid 22.60 a
Application &Plans subject to review beford sua a valid permit f struction.
To [
Any structure other than the principal structure (Rj Iya garage,shed,greenhouse;VED.
etc.{not necessarily limited to the list below).Re Fmational Brochure N
!ui 0.1 2005
Instructions:A permit must be obtained before beginning construction.No inspectionowil BP until the
‘applicant has received a vaiid building permit.All applicants’spaces on this applicati@t lBted and
must appear on the application form. ——
Appicant/Buiider “Precision Construction Owner:Ricdhacd Selkow
Address:Q Conner Dene Address:YR Newport De.
Besta Glens Falls,py JASOR Nonsct,Sy_194SA
Home Phone:S 18>198-2835 Home Phone:\S-GAN-4819
Email Address:=.Email Address:sone cows
Cell Phone:Sie West Cell Phone:iy Gu
FAX Phone:x FAX Phone:BUS 3448S!
Person responsible for supervision of work with respect to building and codes compliance:
Name:e Qluck -Precision Gonstrochen
Address:Cennor S+.,5GensGils,WY 3.4803 Phone SIS-WerS1}
Location of proposed construction:Lot No.Legal Address:VSG Lake “Pareicusasl
<v
Tox Map Number:A26.1S=\-S subdivision Name:La
Estimated Cost of Construction:$.a <a Sco
Does an accessory structure currently exist on the property?Ves J No
YES,Ist all existing accessory structures:“Dock,witty Guadecls Detached Gorage
Proposed Construction Vfloor 24 floor Total |Proposed HeightsatsathSq.ft.f.&in,
‘Open Porch
Covered or Enclosed Porch
[considered floor area &must comply to FAR [Floor Area Ratio
Tequirements if the structure is located in the Waterfront |
Residential zone.
-season porch Is considered an enclosed porch,
Deck.
Boathouse
Boathouse with sundeck
DOCK
1
Shed
Pole Bam asDetachedGarage_1)3 car 136 |Lefr 374.\io TT 10.76"
‘Other Accessory Structure:[}
Applications are subject to Zoning Administrator,Code Compliance,and Structural Plan review.
The Building and Codes Office will allow commencement of your proposed project only after
issuance of your permit.
Declaration:Please sign below after you have carefully read the statement:
To the best of my knowledge,the statements contained in the application,together with the plans and
specifications submitted,are a true and complete statement of all proposed work fo be done on the described
premises and that all provisions of the Building Codes,the Zoning Ordinance,and all other laws pertaining to the
proposed work shall be complied with,whether specified or noted,and that such work is authorized by the owner.
Further,it is understood that I/we shall submit prior to a Certificate of Occupancy or Certificate of Compliance
being issued,as requested by the Zoning Administrator or Director of Building and Codes,an As-Built Survey by a
licensed surveyor,drawn —‘actual location of all new construction ZZDate:LLO.Applicant/Builder sere EAL
The application of dated js hereby approved and
permission granted for the construction,reconstruction or alteration of g building/and or accessory structure as set
forth above.MDat104AuthorizedSignature:As
LAsue Hemingway\Building Permit,FORMS\Accessory Structure Permit Appiication.doc vvs12/28/04